The House of Representatives are planning to vote to repeal the Affordable Care Act. This will be the first time the new Congress has taken up the measure, and the 60th time the Republican-led House has attempted to do so over the last four years. Even if it gets to a vote in the Republican majority Senate, it will inevitably be vetoed.
The same day it was announced that the House planned another repeal vote, Senators Richard Burr (R-N.C.), Tom Coburn, M.D. (R-Okla.), and Orrin Hatch (R-Utah) unveiled the Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act. The press release from the Senate Committee on Finance, of which Senator Hatch is the chairman, describes the CARE Act as “a legislative plan that repeals Obamacare and then replaces it with common-sense, patient-centered reforms that reduce health care costs and increases access to affordable, high-quality care.”
If that sounds a lot like the Affordable Care Act, well, you’re paying attention.
As with all things, it’s the details that matter – and the details are scarce. The two page proposal is filled with talking points. First step, of course, is to repeal the ACA. Yet, they include a lot of the popular aspects of the ACA, such as not being denied coverage for preexisting conditions, continuing health coverage for dependents up to age 26, and prohibiting lifetime limits on coverage. However, if you read further you will see that the plan is nothing more than a return to the days before the ACA.
The proposal allows states to opt out of the continuous coverage for dependents, as well as other provisions that limit how much more insurance companies can charge older individuals. It has replaced the tax subsidy currently available with a refundable tax credit, meaning that people would have to pay full price for their premium and get a refund on their tax return. They are increasing the income level to qualify for this tax credit, which means that fewer people would qualify for Medicaid coverage. As for the Medicaid coverage, they would lower the income rate of eligibility and have a capped amount as to how much each state could spend on the program.
The CARE Act will not allow people to be denied coverage for preexisting conditions but it does not say these individuals cannot be charged more. In fact, the act would reestablish high risk pools for “catastrophic coverage” and health savings accounts. Under the ACA, both of these no longer exist because all plans must have basic coverage and no one can be denied or charged more for a preexisting condition.
Most importantly, under the CARE Act, no employer or individual will be required to purchase insurance if they don’t want to.
In short, the CARE Act is a return to the days of higher insurance premiums and less coverage. Without the employer and individual mandates, people who cannot afford insurance will once again be without options. They admit that their plan has not yet been scored by the Congressional Budget Office, but a think tank called the Center for Health Economy has issued a report that says it will make health insurance more affordable. The Center for Health Economy is a think tank that was started last year and is headed by Republican policy analyst Douglas Holtz-Eakin. It is funded by the American Action Network. The AAN is a political action committee that advocates for “center-right politics”. It has spent hundreds of thousands of dollars on “anti-Obamacare” political messages during campaigns.
These factors should be considered when hearing any “analyses” done about the Republican proposal.
Republicans have already begun their PR campaign for the plan. Last week, an op-ed was published in the Washington Post by a “resident scholar” at another conservative think tank. He set the stage by arguing that less money should be spent by government on health care and that the market should provide options for those who could afford it. He admits that by repealing the ACA, more people would go without coverage and many, very likely, will die. However, as Michael Strain argues, this is an acceptable risk because, quite frankly, we are all going to die anyway and when there are limited resources, tough choices have to be made.
“As with speed limits, gun laws, agency regulations and many other policies, including Obamacare, the shape of future health-care policy will require trade-offs. There are only so many resources, so choices between directing them to health care and allowing them to flow to other uses are inevitable,” Strain glibly points out.
In other words, when Republicans vote for the 60th time to repeal the ACA, they will be saying to America that the poor and the very sick will die and that is perfectly okay because that’s how the free market works.